Transvenous embolization via the inferior petroclival vein for cavernous sinus dural arteriovenous fistula using preoperative and intraoperative image guidance: illustrative case

• DOI: 10.3171/case24574
• Publication Date: 2025-03-25T20:30:36Z
• Authors: Yu Iida; Jun Suenaga; Nobuyuki Shimizu; Taisuke Akimoto; Tetsu Morinobu; Shun Yoshida; Yasunobu Nakai; Tetsuya Yamamoto
• Keywords: Inferior petrosal sinus; Internal jugular vein; Venous plexus; Venography; Sinus (botany)

BACKGROUND The standard approach for transvenous embolization (TVE) of a cavernous sinus (CS) dural arteriovenous fistula (DAVF) involves the inferior petrosal (IPS). However, IPS is often obstructed in many cases. In some cases, not connected to internal jugular vein, making access CS via difficult. petroclival vein (IPCV) runs through extracranial fissures. Although only one case series has reported on treatment DAVF IPCV, no detailed technical tips have been provided. OBSERVATIONS A 76-year-old female presented with right abducens nerve palsy and left ptosis. Angiography revealed bilateral obstructions. Preoperative contrast-enhanced MRI confirmed connecting caudally anterior condylar confluence (ACC) cranially carotid artery venous plexus Rektorzik. Intraoperative venography ACC allowing easy CS. patient’s symptoms resolved after TVE. LESSONS IPCV rarely used due its low anatomical recognition narrow, tortuous structure compared IPS. understanding course preoperative visualizing using intraoperative can facilitate approach. https://thejns.org/doi/10.3171/CASE24574